Promoting Physicians’ Self-Assessment and Quality Improvement: The ABIM Diabetes Practice Improvement Module

Eric S. Holmboe, MD; Thomas P. Meehan, MD, MPH; Lorna Lynn, MD; Paula Doyle, BS, MBA; Tierney Sherwin; and F. Daniel Duffy, MD

The Journal of Continuing Education in the Health Professions, Volume 26, pp. 109-119.

Dr Teirstein Comments

The authors include highly paid employees of the ABIM. The study was funded by the ABIM.

Sixteen practicing general internists and endocrinologists with 10-year time limited certification participated in a beta test of the ABIM’s diabetes practice improvement module (PIM) as part of their recertification program. A PIM consists of a self-directed medical record audit, practice system survey, and patient survey.

Fourteen physicians completed the diabetes PIM. All but 1 physician found the medical record audit provided important information about the practice. Of the 11 physicians who completed a follow-up interview, 10 stated that the quality improvement education specialist helped improve their practice.

The authors conclude, “Self-assessment using practice improvement modules as part of maintenance of certification programs can lead to meaningful behavioral change by physicians in quality improvement.”

The major criticism of this study can be found in the “Limitations” paragraph: “The study has several limitations. First, the sample size was small, and the physicians were self-selected.” In my opinion this means the physicians whose work was studied all volunteered to do the Practice Improvement Module and were likely inclined to support it.

Dr Cohen Comments

Like the preceding study (#7), this is a qualitative research project that attempted to explore physician’s impressions of the diabetes quality improvement module as part of the maintenance of certification process for internal medicine. As a qualitative study, it is mainly meant to be descriptive and hypothesis generating. It does suggest that the physicians who participated in this exercise found the QI module to be of some value to their practice. Whether this truly leads to improved care cannot be determined. In addition, it is difficult to know from the study’s methodology whether the physicians who participated were representative of general practicing physicians and to what extent they were prejudiced to be in favor of a practice improvement module.

Dr Ajay Kirtane Comments

This manuscript reports the self-reported and interview-based outcomes of 16 practicing internists and endocrinologists in Connecticut after participation in a beta test of the ABIM’s diabetes practice-improvement module (PIM). The analysis is largely descriptive, and the most valued items described by the physicians included the practice audit and the patient survey. Notably, 21 physicians began the module and started in the baseline record assessment, but 16 completed the data (dropout rate of >20%). Outcomes related to changing practice (either temporary or lasting) related to performance of PIM are not reported in this publication. This publication well-characterizes the challenges in implementation of a PIM in real-world clinical practice.